title: Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults.
abstract: BACKGROUND
  Low back pain (LBP) is a prevalent and costly condition. Although its etiology is largely unknown, a link to obesity is suspected, and weight loss programs are often recommended to obese patients with LBP.
  
  
  OBJECTIVE
  To assess the efficacy of a pilot, multidisciplinary, medically supervised, nonsurgical weight loss program involving meal replacement, caloric restriction, education, exercise, and group therapy at reducing the severity of LBP in obese adults.
  
  
  METHODS
  Pilot prospective cohort study.
  
  
  METHODS
  A total of 46 obese adults (mean body mass index [BMI] 44.7±7.6 kg/m2) referred to an academic hospital for a multidisciplinary, medically supervised, nonsurgical weight loss program who reported LBP were enrolled.
  
  
  METHODS
  The severity of LBP was measured using the Numerical Pain Scale (NPS) and modified Oswestry Disability Index (ODI) at baseline (Week 1), Week 14, and Week 53; weight, BMI, dietary adherence, and physical activity levels were also measured.
  
  
  METHODS
  The 52-week weight loss program was administered by a team of physicians, dietitians, exercise specialists, and nurses and included liquid meal replacements for 12 weeks, followed by supervised caloric restriction diets for 13 weeks. Participants also attended weekly group therapy and educational meetings for the first 26 weeks, after which they were instructed to continue caloric restriction diets, engage in 60 to 90 minutes of daily physical activity, and attend monthly group meetings for an additional 26 weeks.
  
  
  RESULTS
  At baseline, NPS was mild in 61% (n=28), moderate in 30% (n=14), and severe in 9% (n=4), whereas ODI was moderate in 48% (n=22), severe in 17% (n=8), and crippling in 4% (n=2). At Week 14 (n=42; 92% follow-up), there were significant improvements in NPS (p=.001) and ODI (p=.0005), and significant weight loss (p<.0001). At Week 53 (n=28; 61% follow-up), there was a trend toward improvement in NPS (p=.07), significant improvement in ODI (p=.0009), and significant weight loss (p=.0005); reduction in BMI was significantly associated with clinically important improvements in ODI (p=.046).
  
  
  CONCLUSIONS
  This pilot prospective cohort study suggests that a 52-week multidisciplinary, medically supervised, nonsurgical weight loss program in obese patients with LBP improved both pain and function.
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa Spine Unit, The Ottawa Hospital, Ottawa, Ontario, Canada, K1Y 4E9.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Roffey
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Ashdown
authors.forename: Holly D
authors.initials: HD
authors.lastname: Dornan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Creech
authors.forename: Simon
authors.initials: S
authors.lastname: Dagenais
authors.forename: Robert M
authors.initials: RM
authors.lastname: Dent
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Wai
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015992:Body Mass Index; D004038:Diet, Reducing; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D011615:Psychotherapy, Group; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult